Hornerīs Syndrome vs. Pupillary Asymmetry
Left picture: The diagnosis is a Hornerīs syndrome of the right side with miosis and a narrow lid fissure. Right picture: This girl has a congenital asymmetry of the pupils of unknown origin, which was recognized incidentally following a cerebral concussion. A Hornerīs syndrome is a finding typical for a neurogenic mediastinal tumor, but other causes have to be considered, too. A work-up for mediastinal tumor is necessary if the history and the clinical examination yield no feasible explanation for the pupillary asymmetry.
Both children show an asymmetry of the pupils. They are awake and alert. Left picture: In the boy the left pupil is wider than the right. Right picture: In this girl the right pupil is larger than the left. Left picture: In this case the lid fissure is smaller on the right side than on the left. Right picture: The lid fissure width is identical on both sides. In both patient no drugs have been administered, notably no mydriatics.